Name Change Form

1
Before you begin, you will need to ensure that you have the proper documentation.

To process a name change, TSLIC will require a marriage license, a divorce decree, or a court order.

We will also require a copy of your updated identification with your new name. We can accept a valid drivers license, state identification card, or a U.S. passport.
2
Policy Number* This field is required.
3
Policy Owner Email Address
example@example.com
4
Which of the following are you changing the name of?* This field is required.
Insured
Owner
Both
5
Insured* This field is required.
Name Change
From (Former Name)
Row 0, Column 0
To (New Name)
Row 1, Column 0
Reason for Change
Row 2, Column 0
From (Former Name)
To (New Name)
Reason for Change
Name Change
Row 0, Column 0
Name Change
Row 1, Column 0
Name Change
Row 2, Column 0
1 of 3
6
Date
Date
Month
Day
Year
7
Owner* This field is required.
Name Change
From (Former Name)
Row 0, Column 0
To (New Name)
Row 1, Column 0
Reason for Change
Row 2, Column 0
From (Former Name)
To (New Name)
Reason for Change
Name Change
Row 0, Column 0
Name Change
Row 1, Column 0
Name Change
Row 2, Column 0
1 of 3
8
Date
Date
Month
Day
Year
9
Name Change Documentation* This field is required.Please provide a marriage license, court order, or divorce decree to process this request.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
10
Update Identification* This field is required.Please provide a copy of your update ID with your new name.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
I understand that the requested change will not become effective until the request is received, approved and recorded at the offices of TEXAS SERVICE LIFE INSURANCE COMPANY.
12
Policy Owner Signature* This field is required.
13
Date
Date
Month
Day
Year
14
What Happens Next?

The Policy Owner will fill and sign this form and have one individual sign as witness to the Policy Owner’s signature. Return the completed information to Texas Service Life Insurance Company. When executed by the Company, a copy will be sent to you for your records.

If you have any questions, call the toll free number listed at the bottom of the page.

Please allow (2) business days for the processing of this request.

Your requested change will not become effective until the request is received and recorded at the home office of Texas Service Life Insurance Company.

If you have any questions about this paperwork, please call us at 800-756-7306 and ask for Customer Service or email customerservice@tslic.com and we will be happy to answer any questions you might have.

P.O. BOX 341899, AUSTIN, TEXAS 78734 PH (800) 756-7306 FAX (512) 263-6981 EMAIL: CUSTOMERSERVICE@TSLIC.COM
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